B.C. embracing medical assistance in dying

Chris Walters, right, was dying of colon cancer, and chose doctor-assisted death. His diagnosis was dropped on him like a bomb, says Jana Buhlmann, his wife of less than a year.

Photograph by: Ellie Ericson
, Vancouver Sun

Chris Walters felt angry and cheated on the last morning of his life.

He was just 41 years and one day old when he opted to end his life in September through Medical Assistance in Dying (MAiD) after seven futile rounds of debilitating chemotherapy for Stage 4 colon cancer.

Nearly a year-and-a-half after Canada amended the Criminal Code to legalize physician-assisted death, about 55 terminally ill British Columbians opt for the procedure each month, the highest per-capita rate in Canada. Whether that number grows will depend on resolving some nagging access and doctor-compensation issues.

Walters was suffering. Every treatment left him dizzy and nauseous, made worse by the fact that the chemo wasn’t even meant to cure his cancer, but simply to prolong his life.

He was dying. And that fact was dropped on him like a bomb, according to his wife of less than one year, Jana Buhlmann.

“The oncologist’s first words were ‘We’re not curing this,'” she said. “He didn’t even say hello.”

Walters felt compelled to try palliative chemotherapy to avoid the perception that he had given up.

“He had five different anti-nausea drugs with his chemo, and he still couldn’t get out of bed,” she said.

Buhlmann can’t remember now how the notion of ending Chris’ life came up, or when, but “when he had enough of being poked” he wanted control over how he would go. Walters is one of just a handful of British Columbian under 50 to choose assisted death.

But his natural exit was shaping up to be an excruciating experience.

“He wasn’t afraid of dying. He was terrified of suffering,” she said. “His pain was significant and he was faced with decisions about what to eat, whether to eat, and if he could eat at all.”

In the end, Walters took his leave surrounded by family, including his parents and his son. Like about half of British Columbians who opt for MAiD, he chose to die at home.

“It got complicated, too, when some people reached out in the eleventh hour to try to talk him out of it,” she said.

Patients under 50 may find that their families are not all in agreement about their decision to seek an assisted death, said Dr. Stefanie Green, a Victoria-based MAiD provider.

About 70 per cent of assisted death patients in B.C. are more than 70 years old, with an average age of 74, according to the B.C. Coroners Service. More than half suffer from cancer.

British Columbians have opted for assisted death at a rate well above other provinces, boosted by extraordinary uptake on the Vancouver Island where it is more than five times the national average, at about five per cent of all deaths, said Green, president of the Canadian Association of MAiD Assessors and Providers.

“It’s been astoundingly fast (uptake) on Vancouver Island,” she said. “A lot of people have chosen to retire here and so our demographic is a little older.”

But while demand is high for the service and assisted dying is becoming “normalized” among both patients and physicians, there are some nagging impediments for people who want MAiD.

“Inadequate fees paid to physicians for this work is an embarrassment to British Columbia,” said Green. “It is a distinct obstacle for new providers who want to do this work.”

Doctors who start providing the service often stop when they realize they can’t afford it, she said.

“They soon find they can’t sustain this when it pays half as much as they would get for treating other patients in their office,” said Green. “That leads to a lack of access to MAid for patients. If you don’t have providers, you don’t have service.”

For the provider, B.C. caps paid assessment time at 90 minutes, and provides a flat fee of $200 for the procedure and a home visit allowance of $133.15. Services often include prescribing and obtaining drugs, counselling patients and their families, and completing documents over and above prepping and performing the procedure itself.

Doctors in Alberta make twice as much for the procedure.

There is also a financial argument for improving access to MAiD. Researchers at the University of Calgary have estimated that assisted death could save $139 million in end-of-life health care expenses each year.

The last month of medical care for the average person costs about $14,000, and about $53,000 for the last year, according to a study of patients in Ontario.

“(Assisted death) gives individuals personal autonomy and choice in the face of intolerable suffering, but there are barriers to access built into the system,” said Dying with Dignity spokesman Cory Ruf.

A number of publicly funded hospitals — including St. Paul’s in Vancouver and St. Joseph’s in Comox — don’t allow assisted death on site, meaning patients near the end of life must be moved to another location to get the service, he said.

The law allows doctors and institutions to refuse to participate in MAiD.

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